The document discusses telephone triage and how to determine the urgency of a patient's condition. Common factors to consider include the time factor (how long symptoms have been present), cause (what caused the issue), location (where the pain/problem is located), and whether the condition is known. Based on these details, the triage nurse or provider can determine if the patient needs emergency response, an urgent visit, routine visit, or self-care advice. Examples are given for different scenarios involving fever, injuries, pain, etc.
2. tri-age (French) sorting, sifting “The sorting of and allocation of treatment to patients and esp. battle and disaster victims according to a system of priorities designed to maximize the number of survivors.” Merriam Webster’s Collegiate Dictionary
23. Activate Emergency Response Stated Concern About… Heart Attack Stroke Serious Allergic Reaction Respiratory Distress Major Trauma If the patient declares an emergency, it may not be wise to talk him/her out of it.
27. The Time Factor I “ I have a terrible headache.” “ When did it start?” “ When I was in Vietnam.” “ What made you decide to call today?” “ I got tired of it.” “ Let’s make you an appointment!”
28. The Time Factor II “ I have a terrible headache.” “ When did it start?” “ Yesterday, and I can’t get rid of it.” (There are no acute slots.) “ I’m going to have the nurse call you back as soon as she is free.”
29. The Time Factor III “ I have a terrible headache.” “ When did it start?” “ 20 minutes ago, and it’s getting worse every minute.” “ I’m going to let you talk to a nurse right away!”
36. Common Things Are Common “ Has anyone else been sick with anything like this?”
37. Common Things Are Common “ Has anyone else been sick with anything like this?” “ Have you had anything like this before?” Most patients with indigestion, headache, backache, the flu or hemorrhoids have just that. It is more likely that the patient has a slightly unusual presentation of a common ailment than something exotic.
38. IS THIS AN EMERGENCY? (The Time Factor…with some Cause…) Johnny has an awful cough…
39. IS THIS AN EMERGENCY? (The Time Factor…with some Cause…) Johnny has an awful cough… …after just running around with those glass beads in his mouth!
40. IS THIS AN EMERGENCY? (The Time Factor) Johnny has an awful cough… …after just running around with those glass beads in his mouth! EMERGENCY
41. IS THIS AN EMERGENCY? (The Time Factor) Johnny has an awful cough… …after just running around with those glass beads in his mouth! …it started yesterday and his inhaler isn’t stopping it! EMERGENCY
42. IS THIS AN EMERGENCY? (The Time Factor) Johnny has an awful cough… …after just running around with those glass beads in his mouth! …it started yesterday and his inhaler isn’t stopping it! URGENT EMERGENCY
43. IS THIS AN EMERGENCY? (The Time Factor) Johnny has an awful cough… …after just running around with those glass beads in his mouth! …it started yesterday and his inhaler isn’t stopping it! …that lasts a week every time he goes to the zoo! URGENT EMERGENCY
44. IS THIS AN EMERGENCY? (The Time Factor) Johnny has an awful cough… …after just running around with those glass beads in his mouth! …it started yesterday and his inhaler isn’t stopping it! …that lasts a week every time he goes to the zoo! URGENT EMERGENCY ROUTINE
45. IS THIS AN EMERGENCY? (The Time Factor…with some Cause…) I have a rash…
46. …I just got stung by a bee and I’m breaking out in hives! IS THIS AN EMERGENCY? (The Time Factor) I have a rash…
47. …I just got stung by a bee and I’m breaking out in hives! IS THIS AN EMERGENCY? (The Time Factor) I have a rash… EMERGENCY
48. …I just got stung by a bee and I’m breaking out in hives! …I must have come in contact with poison ivy over the weekend! IS THIS AN EMERGENCY? (The Time Factor) I have a rash… EMERGENCY
49. …I just got stung by a bee and I’m breaking out in hives! …I must have come in contact with poison ivy over the weekend! IS THIS AN EMERGENCY? (The Time Factor) I have a rash… URGENT EMERGENCY
50. …I just got stung by a bee and I’m breaking out in hives! …I must have come in contact with poison ivy over the weekend! …my elbows are thick and scaly like psoriasis! IS THIS AN EMERGENCY? (The Time Factor) I have a rash… URGENT EMERGENCY
51. …I just got stung by a bee and I’m breaking out in hives! …I must have come in contact with poison ivy over the weekend! …my elbows are thick and scaly like psoriasis! IS THIS AN EMERGENCY? (The Time Factor) I have a rash… URGENT EMERGENCY ROUTINE
52. IS THIS AN EMERGENCY? (The Cause Factor) Johnny got hit in the head…
53. IS THIS AN EMERGENCY? …by a wrecking ball that knocked him to the ground! (The Cause Factor) Johnny got hit in the head…
54. IS THIS AN EMERGENCY? …by a wrecking ball that knocked him to the ground! (The Cause Factor) Johnny got hit in the head… EMERGENCY
55. IS THIS AN EMERGENCY? …by a wrecking ball that knocked him to the ground! …by a baseball! (The Cause Factor) Johnny got hit in the head… EMERGENCY
56. IS THIS AN EMERGENCY? …by a wrecking ball that knocked him to the ground! …by a baseball! (The Cause Factor) Johnny got hit in the head… URGENT EMERGENCY
57. IS THIS AN EMERGENCY? …by a wrecking ball that knocked him to the ground! …by a baseball! …by a Nerf ball! (The Cause Factor) Johnny got hit in the head… URGENT EMERGENCY
58. IS THIS AN EMERGENCY? …by a wrecking ball that knocked him to the ground! …by a baseball! …by a Nerf ball! (The Cause Factor) Johnny got hit in the head… URGENT EMERGENCY ROUTINE
59. IS THIS AN EMERGENCY? (The Cause Factor) Mary’s belly hurts…
60. …her period is way late and she’s wicked pale and lightheaded! (The Cause Factor) Mary’s belly hurts… IS THIS AN EMERGENCY?
61. …her period is way late and she’s wicked pale and lightheaded! (The Cause Factor) Mary’s belly hurts… IS THIS AN EMERGENCY? EMERGENCY
62. …her period is way late and she’s wicked pale and lightheaded! …she’s got cramping and diarrhea. The rest of us have just gotten over the stomach flu! (The Cause Factor) Mary’s belly hurts… IS THIS AN EMERGENCY? EMERGENCY
63. …her period is way late and she’s wicked pale and lightheaded! …she’s got cramping and diarrhea. The rest of us have just gotten over the stomach flu! (The Cause Factor) Mary’s belly hurts… IS THIS AN EMERGENCY? URGENT EMERGENCY
64. …her period is way late and she’s wicked pale and lightheaded! …she’s got cramping and diarrhea. The rest of us have just gotten over the stomach flu! …every morning before the school bus! (The Cause Factor) Mary’s belly hurts… IS THIS AN EMERGENCY? URGENT EMERGENCY
65. …her period is way late and she’s wicked pale and lightheaded! …she’s got cramping and diarrhea. The rest of us have just gotten over the stomach flu! …every morning before the school bus! (The Cause Factor) Mary’s belly hurts… IS THIS AN EMERGENCY? URGENT EMERGENCY ROUTINE
66. (The Location Factor – stay away from the high rent districts!) I suddenly got this excruciating pain in my… IS THIS AN EMERGENCY?
67. …abdomen …head …chest (The Location Factor – stay away from the high rent districts!) I suddenly got this excruciating pain in my… IS THIS AN EMERGENCY?
68. …abdomen …head …chest (The Location Factor – stay away from the high rent districts!) I suddenly got this excruciating pain in my… IS THIS AN EMERGENCY? EMERGENCY
69. …abdomen …head …chest …big toe …ankle …knee (The Location Factor – stay away from the high rent districts!) I suddenly got this excruciating pain in my… IS THIS AN EMERGENCY? EMERGENCY
70. …abdomen …head …chest …big toe …ankle …knee (The Location Factor – stay away from the high rent districts!) I suddenly got this excruciating pain in my… IS THIS AN EMERGENCY? URGENT EMERGENCY
71. …abdomen …head …chest …big toe …ankle …knee …tooth (The Location Factor – stay away from the high rent districts!) I suddenly got this excruciating pain in my… IS THIS AN EMERGENCY? URGENT EMERGENCY
72. …abdomen …head …chest …big toe …ankle …knee …tooth (The Location Factor – stay away from the high rent districts!) I suddenly got this excruciating pain in my… IS THIS AN EMERGENCY? URGENT EMERGENCY ROUTINE
77. FEVER Is there a dangerous temperature? Not really! Fever is a symptom. We look for the cause. Sometimes we don’t find it…
78. FEVER Is there a dangerous temperature? Not really! Fever is a symptom. We look for the cause. Sometimes we don’t find it… In infants under one year we MUST find the cause, because they may have atypical presentations of meningitis and other serious infections.
84. INGESTED OBJECTS Usually, once swallowed, objects make it all the way through to the other end. Sometimes we x-ray the abdomen to make sure they make it through the stomach and into the small intestine.
86. DIARRHEA AND VOMITING We try to QUANTIFY to decide on severity “How many times have you had diarrhea? Every time!” (…is not good enough!)
87. DIARRHEA AND VOMITING We try to QUANTIFY to decide on severity “How many times have you had diarrhea? Every time!” (…is not good enough!) Generally no cure.
88. DIARRHEA AND VOMITING We try to QUANTIFY to decide on severity “How many times have you had diarrhea? Every time!” (…is not good enough!) Generally no cure. Don’t make it worse - advise the BRAT diet: Banana Rice Applesauce Toast NO MILK
89. DIARRHEA AND VOMITING We try to QUANTIFY to decide on severity “How many times have you had diarrhea? Every time!” (…is not good enough!) Generally no cure. Don’t make it worse - advise the BRAT diet: Banana Rice Applesauce Toast Caution: Bloody or black diarrhea is an emergency, although Pepto Bismol makes stool black. NO MILK
92. PAIN AND SWELLING Is the cause known or suspected? Ankle pain after falling off a roof?
93. PAIN AND SWELLING Is the cause known or suspected? Ankle pain after falling off a roof? Is somebody liable?
94. PAIN AND SWELLING Is the cause known or suspected? Ankle pain after falling off a roof? Is somebody liable? If it happened on the job, it MUST be processed as a Worker’s Comp case.
95. PAIN AND SWELLING Is the cause known or suspected? Ankle pain after falling off a roof? Is somebody liable? If it happened on the job, it MUST be processed as a Worker’s Comp case. Motor vehicle accidents with personal injuries must be investigated by the police.
98. WORK INJURIES Must be processed as such. Employer chooses provider for the first 10 days.
99. WORK INJURIES Must be processed as such. Employer chooses provider for the first 10 days. First visit will be billed as a New Patient Visit, takes longer and involves enough paperwork to document future court case.
100. WORK INJURIES Must be processed as such. Employer chooses provider for the first 10 days. First visit will be billed as a New Patient Visit, takes longer and involves enough paperwork to document future court case. M-1 form must be completed first and last visit, and every 30 days in between.
102. MOTOR VEHICLE ACCIDENTS Motor Vehicle Accidents with personal injuries must be reported to the police at the time of the accident.
103. MOTOR VEHICLE ACCIDENTS Motor Vehicle Accidents with personal injuries must be reported to the police at the time of the accident. Often many x-rays are needed, which can strain our staff resources. CT scans are often needed.
104. MOTOR VEHICLE ACCIDENTS Motor Vehicle Accidents with personal injuries must be reported to the police at the time of the accident. Often many x-rays are needed, which can strain our staff resources. CT scans are often needed. MVA’s are often referred to the ER.
107. BACK PAIN Is the cause known? (Yes) Unless there is neurological deficit (urine, bowels, leg weakness), mechanical back pain is generally not an emergency. Most mechanical back pain gets better lying down. Generally no acute x-rays needed.
109. BACK PAIN Is the cause known? (No) Uncommon causes include: Kidney stone Gallbladder Attack Blood clot in lung Collapsed lung Ruptured aneurysm Pancreatitis UTI